Outline

Objective: Diving into “unknown” shallow water has a high risk of cervical spine injury. Neurological impairment after trauma may be devastating and irreversible. This study presents our experience with patients presenting with diving injuries.

Methods: A retrospective study of 26 patients with cervical spine injuries, who were consecutively admitted to our institution between 1993 and 2006 was performed. Demographic data, type of trauma, surgical and non-surgical treatment, American Spinal Injury Association (ASIA) scale on admission and discharge, Barthel-Index on discharge, associated injuries as well surgical and non-surgical complications were evaluated.

Results: The average age was 24.5 years (14 to 45 years) with a predominance of male patients (m: 25; f: 1). Two accidents were related to pool diving whereas the remaining patients were injured after jumping into the Baltic Sea or lakes. 10 patients were non-residents. Altogether 32 vertebral fractures occurred in 24 patients. The fractures were located) predominantly at the levels of C6 (9), C5 (8) and C7 (8). One patient sustained a disco-ligamentary instability. Another patient presented with a traumatic rupture of the cervical disc C3/4. No intracranial injuries were found. At least four patients reported a short period of a loss of consciousness. 12 patients demonstrated clinically relevant neurological deficits with an ASIA scale A to D (A: 5; B: 3; C: 3; D:1). Trauma associated vertebral artery occlusion or dissection was found in two patients. Complex cervical spine surgery was performed because of unstable conditions in 22 patients, whereas conservative treatment was indicated in four patients. There was one surgery-related recurrent nerve paresis. Non-surgical complications were observed in six patients (pneumonia: 2; urinary tract infection: 2; undetermined febrile conditions: 2). On discharge five patients had improved neurologically. However, only two patients demonstrated an improvement in the ASIA scale. No patient with ASIA A or B improved. Six patients were discharged to rehabilitation with a Barthel-Index of less than 30 (5: 0; 1: 30). 18 patients were available for follow-up examinations (mean 16.2 months). Only one patient had significantly improved from ASIA C to D.

Conclusions: Severe diving injuries of the cervical spine generally result in unstable fractures and require early surgery. Devastating neurological impairment occurred in approximately 50% of the patients. Functional recovery was closely dependent on the primary damage of the spinal cord. An ASIA scale of A or B on admission predicted the worst outcome.